A 42-year-old man presents to the emergency department (ED) for evaluation of a severe rash that mostly affects his face, torso, and armpits, the latter of which is the most severely affected area.  The rash has occurred in the past and the patient’s physician prescribed a topical cream, but he does not recall what type of cream or any additional details about the condition. The rash is both painful and itchy. The patient has not had fever.  He has no other complaints.

The patient’s vital signs are normal; physical examination is normal except for the rash on the anterior torso, face, and armpits.  The patient has not applied cream or deodorant to his armpits. He believes that the white patch in his armpit is dead skin.  

Differential diagnoses include an allergic reaction, hidradenitis suppurativa, cellulitis, and syphilis. Laboratory testing reveals normal complete blood cell count, basal metabolic panel, and liver function test. No diagnostic imaging is performed.

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